Insurers, health systems, state health plans and self-funded employers are all grappling with how to cover the high cost of GLP-1 medications, with some large organizations limiting coverage or dropping benefits entirely in 2024.
Chronis Manolis, senior vice president, pharmacy and chief pharmacy officer at UPMC Health Plan, joined the Becker's Payer Issues podcast to discuss his perspective on the medications and how the insurer is managing access to them.
Question: How is UPMC Health Plan dealing with the GLP-1 insanity that has dominated the pharmacy space recently?
Chronis Manolis: It's important to separate the two types of GLP-1s: those for diabetes, like Ozempic and Mounjaro, and those for weight loss. The population tends to blend them together, partly due to shortages. People are using one in place of the other, and that's impacting diabetics. The demand for these drugs is incredible, with sequential double-digit growth quarter over quarter. I can’t recall another drug category with that level of action.
For weight loss drugs, most plans don't cover them. Medicare excludes them for now, but that will likely change as pressure mounts from all sides. You can’t blame obesity for many downstream health issues and then not cover these drugs, especially when they're so effective. It's different now because these drugs show potential for 15% body weight reduction. But the population affected is massive, and the early data is still coming in, particularly around discontinuation rates. What have we really accomplished if people gain the weight back? Not everyone does, but it’s a concern.
We’re also seeing compounding shops pop up, and manufacturers are going directly to consumers. That's rare to see. My challenge is that these are great diabetes drugs. We went through a period with limited options for Type 2 diabetes, but now these drugs are cardioprotective, help with weight loss, and reduce A1C levels. However, the explosion in cost and demand has led stakeholders to push for more management — more prior authorizations — because the costs are unsustainable.
I’ve been at UPMC for more than 18 years and in managed care for a long time, and I can’t recall a time when we put barriers on diabetes drugs. This is something to consider as we move forward, especially when future innovations could be even greater. That’s the challenge. But coming from an industry with many such 'blips,' I’m confident we’ll manage through this.